Provider Demographics
NPI:1154432912
Name:DEVOGHT, ANDRA C (PT, MPH)
Entity type:Individual
Prefix:
First Name:ANDRA
Middle Name:C
Last Name:DEVOGHT
Suffix:
Gender:F
Credentials:PT, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2537
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-2537
Mailing Address - Country:US
Mailing Address - Phone:206-953-1133
Mailing Address - Fax:844-666-7401
Practice Address - Street 1:17641 VASHON HWY SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070
Practice Address - Country:US
Practice Address - Phone:206-953-1133
Practice Address - Fax:844-666-7401
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist